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General NPI Number Information
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NPI Number | 1548259617
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Entity Type | Individual
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Provider Name | SAMUEL T DETWILER D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 2323 MEMORIAL AVE STE 10
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City | LYNCHBURG
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State | VA
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Zip | 24501-2652
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Country | US
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Telephone | 434-200-5200
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Fax | 434-200-5200
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Provider Business Mailing Address
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Address Line | 7126 FAIRWAY DR
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City | BUTLER
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State | PA
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Zip | 16001-8596
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Country | US
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Telephone | 724-256-6960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34-00-7985
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS016525
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102209331
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License Number State | VA
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